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1Centre for Primary Care and Public Health, Queen Mary University of London, London E1 4NS, UK

Correspondence to: A M Pollock a.pollock{at}qmul.ac.uk

Accepted 13 March 2015

Despite the high rates of injury in rugby, the UK government plans to focus on increasing participation in the sport in schools. Andreas Freitag, Graham Kirkwood, and Allyson Pollock discuss whether surveillance and prevention programmes from around the world have reduced rugby injuries

Since rugby union became a professional sport in 1995 its popularity has increased such that the Six Nations Championship in 2014 had a higher average attendance per game than either the UEFA Euro Cup 2012 or the FIFA World Cup 2014.123 Rugby (both union and league) is the third most popular team contact sport worldwide.4 Rugby union is played in around 120 countries and rugby league in around 40.56 England has the largest number of rugby union players in the world—over two million, which is almost 40% of the world total.5

The high rates of injury in rugby union and rugby league for professional and amateur players, including children, are well established and a cause for medical concern.78910111213 Around 12% of child and adolescent rugby players sustain an injury severe enough to require at least seven days’ absence from playing in a season.12 A meta-analysis of rugby injuries among adult rugby union players found an overall incidence of injury of 81 per 1000 player hours,14 three times that of child and adolescent players (26.7 per 1000 player hours).12 So adult players can expect to be injured once every 9.3 matches on average, assuming that each match is 80 minutes long.

Recent high profile cases have exposed the mismanagement of concussion on the rugby field, sometimes with fatal consequences.1516 The risk of concussion and reduced cognitive and motor function in later life is also high in other …